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OP0220 (2021)
SECULAR TRENDS IN BASELINE CHARACTERISTICS, TREATMENT RETENTION AND RESPONSE RATES IN 17453 BIONAÏVE PSORIATIC ARTHRITIS PATIENTS INITIATING TNFI – RESULTS FROM THE EUROSPA COLLABORATION
S. N. Christiansen1, L. Midtbøll Ørnbjerg1, S. H. Rasmussen1, A. G. Loft2,3, J. K. Wallman4, F. Iannone5, B. Michelsen1,6, M. J. Nissen7, J. Zavada8, M. J. Santos9, M. Pombo-Suarez10, K. Eklund11, M. Tomsic12, B. Gudbjornsson13, İ. Sari14, C. Codreanu15, D. DI Giuseppe16, B. Glintborg1,3, M. Sebastiani17, K. M. Fagerli6, B. Moeller18, K. Pavelka8, A. Barcelos19, C. Sánchez-Piedra20, H. Relas11, Z. Rotar12, T. Love13, S. Akar21, R. Ionescu15, G. Macfarlane22, M. G. H. Van de Sande23, M. L. Hetland1,3, M. Østergaard1
1Rigshospitalet Glostrup, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Glostrup, Denmark
2Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
3Rigshospitalet Glostrup, DANBIO Registry, Glostrup, Denmark
4Skåne University Hospital, Lund University, Lund, Sweden
5University of Bari, Rheumatology Unit, Bari, Italy
6Diakonhjemmet Hospital, Division of Rheumatology, Oslo, Norway
7Geneva University Hospital, Department of Rheumatology, Geneva, Switzerland
8Institute of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
9Hospital Garcia de Orta, Rheumatology Department, Almada, Portugal
10Hospital Clinico Universitario, Rheumatology Service, Santiago de Compostela, Spain
11Helsinki University Hospital, Department of Rheumatology, Helsinki, Finland
12University Medical Centre Ljubljana, Department of Rheumatology, and Universitiy of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
13Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
14Dokuz Eylul University School of Medicine, Division of Rheumatology, Izmir, Turkey
15University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania
16Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
17University of Modena and Reggio Emilia, Rheumatology Unit, Modena, Italy
18Inselspital, University Hospital Bern, Department Rheumatology & Immunology, Bern, Switzerland
19Centro Hospitalar do Baixo Vouga, Department of Rheumatology, Aveiro, Portugal
20Sociedad Española de Reumatologia, Research Unit, Madrid, Spain
21Katip Celebi University School of Medicine, Division of Rheumatology, Izmir, Turkey
22University of Aberdeen, Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom
23Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam UMC/AMC, University of Amsterdam, Amsterdam, Netherlands

Background: Knowledge of changes over time in baseline characteristics and tumor necrosis factor inhibitor (TNFi) response in bionaïve psoriatic arthritis (PsA) patients treated in routine care is limited.


Objectives: To investigate secular trends in baseline characteristics and retention, remission and response rates in PsA patients initiating a first TNFi.


Methods: Prospectively collected data on bionaïve PsA patients starting TNFi in routine care from 15 European countries were pooled. According to year of TNFi initiation, three groups were defined a priori based on bDMARD availability: Group A (1999–2008), Group B (2009–2014) and Group C (2015–2018).

Retention rates (Kaplan-Meier), crude and LUNDEX adjusted 1 remission (Disease Activity Score (DAS28) <2.6, 28-joint Disease Activity index for PsA (DAPSA28) ≤4, Clinical Disease Activity Index (CDAI) ≤2.8) and ACR50 response rates were assessed at 6, 12 and 24 months. No statistical comparisons were made.


Results: A total of 17453 PsA patients were included (4069, 7551 and 5833 in groups A, B and C).

Patients in group A were older and had longer disease duration compared to B and C. Retention rates at 6, 12 and 24 months were highest in group A (88%/77%/64%) but differed little between B (83%/69%/55%) and C (84%/70%/56%).

Baseline disease activity was higher in group A than in B and C (DAS28: 4.6/4.3/4.0, DAPSA28: 29.9/25.7/24.0, CDAI: 21.8/20.0/18.6), and this persisted at 6 and 12 months. Crude and LUNDEX adjusted remission rates at 6 and 12 months tended to be lowest in group A, although crude/LUNDEX adjusted ACR50 response rates at all time points were highest in group A. At 24 months, disease activity and remission rates were similar in the three groups ( Table ).

Secular trends in baseline characteristics, treatment retention, remission and response rates in European PsA patients initiating a 1st TNFi

Baseline characteristics Group A (1999–2008) Group B (2009–2014) Group C (2015–2018)
Age, median (IQR) 62 (54–72) 58 (49–67) 54 (45–62)
Male, % 51 48 47
Years since diagnosis, median (IQR) 5 (2–10) 3 (1–9) 3 (1–8)
Smokers, % 16 17 17
DAS28, median (IQR) 4.6 (3.7–5.3) 4.3 (3.4–5.1) 4.0 (3.2–4.8)
DAPSA28, median (IQR) 29.9 (19.3–41.8) 25.7 (17.2–38.1) 24.0 (16.1–35.5)
CDAI, median (IQR) 21.8 (14.0–31.1) 20.0 (13.0–29.0) 18.6 (12.7–26.1)
TNFi drug, % (Adalimumab / Etanercept / Infliximab / Certolizumab / Golimumab) 27 / 43 / 30 / 0 / 0 36 / 31 / 14 / 5 / 14 21 / 40 / 21 / 8 / 10
Follow up 6 months 12 months 24 months
Gr A Gr B Gr C Gr A Gr B Gr C Gr A Gr B Gr C
Retention rates , % (95% CI) 88 (87–89) 83 (82–84) 84 (83–85) 79 (78–80) 72 (71–73) 72 (71–73) 68 (67–69) 60 (59–61) 60 (59–62)
DAS28 , median (IQR) 2.7 (1.9–3.6) 2.4 (1.7–3.4) 2.3 (1.7–3.2) 2.5 (1.8–3.4) 2.2 (1.6–3.1) 2.1 (1.6–2.9) 2.1 (1.6–3.1) 2.0 (1.6–2.9) 1.9 (1.5–2.6)
DAPSA28 , median (IQR) 10.6 (4.8–20.0) 9.5 (3.9–18.3) 8.7 (3.6–15.9) 9.1 (4.1–17.8) 7.7 (3.1–15.4) 7.6 (2.9–14.4) 6.7 (2.7–13.7) 6.6 (2.7–13.5) 5.9 (2.4–11.8)
CDAI , median (IQR) 7.8 (3.0–15.2) 8.0 (3.0–15.0) 6.4 (2.6–12.2) 6.4 (2.5–13.0) 6.2 (2.5–12.1) 5.8 (2.2–11.4) 5.0 (2.0–11.0) 5.5 (2.0–11.2) 5.0 (2.0–9.0)
DAS28 remission , %, c/L 47 / 42 55 / 46 61 / 51 53 / 43 62 / 45 66 / 48 64 / 42 68 / 37 75 / 41
DAPSA28 remission , %, c/L 22 / 19 26 / 22 28 / 23 25 / 20 31 / 22 32 / 23 36 / 23 34 / 19 38 / 21
CDAI remission , %, c/L 23 / 21 23 / 19 26 / 22 27 / 21 27 / 20 29 / 21 34 / 22 31 / 17 35 / 19
ACR50 response , %, c/L 26 / 23 22 / 18 24 / 20 27 / 22 23 / 17 21 / 15 23 / 15 18 / 10 14 / 8

Gr, Group; c/L, crude/LUNDEX.


Conclusion: Over the past 20 years, patient age, disease duration and disease activity level at the start of the first TNFi in PsA patients have decreased. Furthermore, TNFi retention rates have decreased while remission rates have increased, especially remission rates within the first year of treatment. These findings may reflect a greater awareness of early diagnosis in PsA patients, a lowered threshold for initiating TNFi and the possibility for earlier switching in patients with inadequate treatment response.


REFERENCES:

[1]Arthritis Rheum 2006; 54: 600-6.


Acknowledgements: Novartis Pharma AG and IQVIA for supporting the EuroSpA Research Collaboration Network.


Disclosure of Interests: Sara Nysom Christiansen Speakers bureau: BMS and GE, Grant/research support from: Novartis, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Simon Horskjær Rasmussen: None declared, Anne Gitte Loft Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Grant/research support from: Novartis, Johan K Wallman Consultant of: Celgene, Eli Lilly, Novartis, Florenzo Iannone Speakers bureau: Abbvie, MSD, Novartis, Pfizer and BMS, Brigitte Michelsen Consultant of: Novartis, Grant/research support from: Novartis, Michael J. Nissen Speakers bureau: Novartis, Eli Lilly, Celgene, and Pfizer, Consultant of: Novartis, Eli Lilly, Celgene, and Pfizer, Jakub Zavada: None declared, Maria Jose Santos Speakers bureau: AbbVie, Novartis, Pfizer, Manuel Pombo-Suarez: None declared, Kari Eklund: None declared, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, İsmail Sari: None declared, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Daniela Di Giuseppe: None declared, Bente Glintborg Grant/research support from: Pfizer, Biogen, AbbVie, Marco Sebastiani: None declared, Karen Minde Fagerli: None declared, Burkhard Moeller: None declared, Karel Pavelka Speakers bureau: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Consultant of: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Anabela Barcelos: None declared, Carlos Sánchez-Piedra: None declared, Heikki Relas: None declared, Ziga Rotar Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Thorvardur Love: None declared, Servet Akar: None declared, Ruxandra Ionescu Speakers bureau: Abbvie, Amgen, Boehringer-Ingelheim Eli-Lilly,Novartis, Pfizer, Sandoz, UCB, Gary Macfarlane Grant/research support from: GlaxoSmithKline, Marleen G.H. van de Sande: None declared, Merete L. Hetland Speakers bureau: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis., Mikkel Østergaard Speakers bureau: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth, Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth

Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 131
Session: Unrevealing the impact of PsA and comorbidity prevention (Oral Presentations)